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FOR OFFICE USE: T APPLICATION FOR SANITATION PERMIT --------------- {Complete in Triplicate} /Date ermit No. ------------------------- This Permit Expires ] Year From Date Issued Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is made in compliance with County Ordinance'No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION _.�Z/ 1.t✓-: � } D'r- t*_y— ---------------------------CENSUS TRACT ---------------- --------- Owner's Name ------ /��/ C{ /h -------------------------------------Phone.'`_ F??7-_!'�/7-------- Address ----- ' City ------- ---•--------- Contractor's Name _ ---------------------- License - ®__ Phonee 540_ Installation will serve: Residence []Apartment House❑ Commercial :❑Trailer Court ❑ Motel ❑Other Number of living units:- ------ Number of bedrooms �-.-___Garbage Grinder:� .._ Lot Size ___!-x_,0744 f!FsP Water Supply: Public System and name --------- -- - -------------------------------------- ------------------------------------------------------Private LA__ Character of soil to a depth of 3 feet; Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam Em—, Hardpan ❑ Adobe ❑ Fill Material If yes,type _.._______________________ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANKSize?--x_ X _��{.. _ T - _ ____ ______________ Liquid Depth _ �r '[ ---_---------- Capacity 42-049----- Type*r7_9A4?_____ MaterialaWW_,67Z. No. Compartments _°'�___--------------- Distance to nearest: Well ------------------------Foundation ----------- Prop. Line _______.___._ LEACHING LINE [LT111,No, of Lines _A--------------- Length of each line__AQ------------------ Total Length 6_V_--_____________. N 'D' Box _L/-___ Type Filter Materiald (fk--______Depth Filter Material ________________________________ _,9 Property le ' r Distance to nearest: Well -�------------------ Foundation /�------------------ Pro er Line ------------------------ SEEPAGE PIT Depth ____ Diameter _______________ Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ---_---.------------ Distance to nearest: Well _______._______________________________Foundation ----&-------------- Prop. Line _______-___-_-___--__ REPAIR/ADDITION{Prev. Sanitation Permit# ____________________________________________ Date _.._---___________________________) SepticTank (Specify Requirements) ----------- ------------------------------------------------------------------------------------------------ - --------------------------•- DisposalField (Specify Requirements) ------------------------- ------------------------------------------------------------------------------------------------ ---------- (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: to "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------------------- Owner � - --- -------------------------------------------------- -------------- (If other than ner) FOR. P T USE.. NLY 4.4 APPLICATION ACCEPTED BY __-----------_ - _ ------- DATE - _------------- BUILDING _.___._. _ _BUILDING PERMIT ISSUED ----------------- �.-----.._.DATE --- ------------ _------- ADDITIONAL COMMENTS ---------- ---- ... --------------- C"¢-- ---------- --- ---- - Final Inspection by -------- --- �6 -- -- Date _ �9_ 2_7� AQUIN-LO H H DISTRICT E. H. 9 1-'68 Rev. 5M 0t.Q.2c